Breastfeeding Troubleshooting Guide

From providing free, ideal nutrition for your baby to parent-child bonding, the benefits of breastfeeding are significant. But breastfeeding may be a challenge, particularly when you first start. Here’s how to address common breastfeeding issues:

  • Sore Nipples. When your baby sucks on the nipple, it can result in tenderness. (If your nipple looks flat or compressed after nursing, this may be the issue.) To help, gently break your baby’s attachment to the breast by placing a clean finger in your baby’s mouth, then try latching on again. After breastfeeding, express a few drops of milk — which has antibacterial properties — and gently rub it onto your nipples with clean hands, or use warm compresses or nipple cream for relief. Avoid tight-fitting clothing or bras, which can be irritating.
  • Engorgement. When your breasts become so filled with milk — engorged — that they feel hard and painful, it can lead to plugged ducts or a breast infection. Prevent engorgement by breastfeeding often after giving birth, allowing your baby to feed as long as they like. Breastfeeding often allows milk to flow and leave, preventing the breast from over-filling again. Warm compresses before feedings can help milk flow; cold compresses after feeding can help ease swelling. Massaging can help soften the breast.
  • Strong Let-Down/Milk Ejection. A strong milk ejection reflex or let-down causes a rush of milk, which can cause your baby to choke on too much liquid. To help, hold your nipple between your fingers and lightly compress milk ducts to slow down the milk ejection. If your baby sputters or chokes while breastfeeding, gently break the latch with your finger and allow the excess milk spray onto a cloth. Let your baby come on and off the breast as needed.
  • Plugged Duct. Common in breastfeeding mothers, a plugged milk duct feels like a tender and sore lump in the breast, and is the result of milk not draining properly. When pressure builds up behind the plug, surrounding tissue gets inflamed and sore. To help, use warm compresses and massage behind the sore spot, moving your fingers in a circular motion toward the nipple. Breastfeed on the affected side, aiming your baby’s chin at the plug. Feed up to every two hours to loosen the plug and keep milk flowing. Call your doctor if you develop a fever or if the plugged duct doesn’t go away within a few days.
  • Breast Infection (Mastitis). Mastitis is a breast infection that can cause fever or flu-like symptoms, aches, nausea, vomiting and a yellowish discharge. Breasts may be sore or have a lump, feel warm or hot to the touch, and appear pink or red. To ease symptoms and keep milk moving, breastfeed on the affected side every two hours or more often. Get lots of rest, take hot showers and massage the area, moving your fingers in a circular motion. Call your health care practitioner if your symptoms do not improve within a day.
  • Yeast/Fungal Infections. Nipple soreness; achy breasts; shiny, itchy, or cracked nipples; and shooting pains in the breast during or after feedings are all signs of yeast/fungal infections, also known as thrush. These infections can spread and last for weeks; be sure to wash any towels, sheets and clothing that may come into contact with the yeast in very hot water. Wash your hands (and your baby’s) often; boil pacifiers, bottle nipples, toys and anything else your baby puts in their mouth, and change disposable nursing pads frequently.
  • Too Little Milk. While most mothers make enough milk, you can help ensure a good supply by getting plenty to drink and eating healthy food while nursing. (Drink a full glass of water every time you nurse.) To help make sure your baby is getting enough to eat, nurse your baby often and let baby decide when to stop feeding. Pump after feeding if your baby does not empty the breast. When you empty your breasts, you produce more milk. If you have concerns about your baby getting enough, speak with your pediatrician.
  • Too Much Milk. When breasts are too full, it can make breastfeeding uncomfortable and can lead to plugged ducts, mastitis, and other issues. Too-full breasts may also cause your baby to swallow air (which can cause discomfort), gasp or even choke; burp them often. Express by hand to relieve pressure, and breastfeed on one side for each feeding. Change nursing positions; keep offering the same breast until your baby has nursed for at least fifteen minutes. Use a cold compress or washcloth to reduce discomfort and swelling.
  • Nursing Strike. When your nursing baby suddenly refuses the breast, they are on a nursing “strike.” A nursing strike may mean that your baby is trying to tell you something is wrong, such as mouth pain from teething, a cold sore, or thrush, ear pain from an infection, a cold or other issues. To help, try another feeding method temporarily and express milk to avoid engorgement and plugged ducts. Keep track of your baby’s wet and dirty diapers to be sure they are eating enough. Try breastfeeding while your baby is sleepy, which may be more successful. Speak to your pediatrician if you think the issue may be an ear infection or thrush, or if the “strike” doesn’t end within a couple of days.

Warning Signs

Most issues with breastfeeding resolve quickly and are not serious, but some are very dangerous and need medical attention. Contact your health care provider immediately if you have…

  • a breast infection in both breasts
  • pus or blood in your breast milk
  • red streaks near the affected area of the breast
  • severe and sudden symptoms

Did you know that Los Angeles County has a great variety of free or low-cost lactation coaches and experts available to help with breastfeeding

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